“Do the salient characteristics that lead to diagnosis of abnormality reside in the patients themselves, or in the environment and contexts in which observers find them?”
If ‘normal’ people attempt to be admitted to psychiatric hospitals, will they be detected as being sane, and if so how?
Subjects
8 ‘sane’ people: a graduate, 3 psychologists, a paediatrician, a painter, a housewife and the author.
Method
They attempted to gain admission to 12 different hospitals in 5 different US states. They telephoned for an appointment and arrived complaining that they had been hearing voices- unfamiliar, same sex as themselves, unclear but said ‘empty hollow thud’. This was chosen because these symptoms simulated an Existential Crisis (who am I? What is it all for?), which could arise from concerns about how meaningless your life is. (Existential Psychosis is not mentioned in the literature)
These pseudopatients gave false names and job descriptions (to protect their future health and employment records). All other details were true.
After being admitted, the pseudopatients stopped simulating any symptoms, took part in ward activities and spent time writing notes about the staff and patients. They were required to get out by convincing staff of their sanity.
Results
- All disliked the experience and wished to be discharged immediately.
- All were admitted.
- All but one were admitted as ‘schizophrenic’, even though there were no clear symptoms of the disorder.
- They remained for 7-52 days (average: 19 days) and were eventually discharged as having ‘schizophrenia in remission.’
- They were not detected as frauds by the staff, but many of the patients suspected their sanity. (35 out of 118 patients voiced their suspicions)
- They were given 2100 medication tablets (only 2 were swallowed and the rest were put down the toilet or pocketed). They found the medications of the other patients were also often put down the toilet. As long as the patients were cooperative, their behaviour went unnoticed.
- The nurses stayed in their offices 90% of the time.
- The total time a patient spent with psychiatrists/psychologists/registrars was under 7 minutes each day.
Follow-up Study
A teaching and research hospital, aware of the first study, was informed that during the next 3 months, one or more pseudopatients would attempt to be admitted into the hospital.
Each staff member rated on a 10-point scale each new patient as to the likelihood of their being a pseudopatient. ≈ 10% were suspected by 1 psychiatrist and another member of staff. However no pseudopatients had attempted admission.
Discussion
Rosenhan claims, ‘it is clear that we cannot distinguish the sane from the insane in psychiatric hospitals’. It also illustrates depersonalisation and powerlessness created by psychiatric hospitals.
He pointed out that behaviour was systematically reinterpreted according to the expectations of the staff. He suggested that rather than labelling, it would be more useful to discuss the behaviours and the stimuli that provoke them.
He notes, that although the pseudopatients had negative experiences, they do not describe the experiences of real patients. This would be a consequence of participant observation.
General Observations
Whilst in hospitals the pseudopatients’ normal behavioural patterns were overlooked. For example, the nursing records showed the writing behaviour was pathological for 3 patients.
Also in another incident, whilst a group of patients were waiting outside the café half an hour before lunchtime, a psychiatrist addressing a group of registrars, suggested that this behaviour was an ‘oral-acquisitive syndrome’, hence everyday human activities were interpreted as pathological.
When the pseudopatients approached a staff member with a simple polite request, e.g. ‘pardon me Mr/Mrs/Dr X. Could you please tell me when I will be presented at the staff meeting?’, many moved on with their head averted. It was found that very few stopped and talked. They were treated as if they were invisible. (This was unlike a university study in which nearly all the requests were acknowledged.)
Depersonalisation and powerlessness: Deprived of many human rights, e.g. freedom of movement, privacy (medical records), and toilets did not have doors. Some orderlies would be brutal in full view of other patients, but would stop when other members of staff approached- showing that staff were credible witnesses but patients were not.
